Who asks an anonymous physician blogger for advice?

I’m often asked why I use a pseudonym. When I first started blogging almost 4 years ago, I was still in practice. Some of my posts are a little edgy and my sense of humor is not for everyone. I didn’t want patients to Google me and have my blog come up on the first page of hits.

Now that I’ve been retired for over a year, I still have not revealed my true identity. You may ask, “Why not?”

I like being anonymous. I feel that I can be more honest because I am not worrying about what someone is going to think. A quote from Oscar Wilde says it all: “Man is least himself when he talks in his own person. Give him a mask, and he will tell you the truth.”

Some people have questioned my credibility. They say how can anyone believe what you write when they don’t know who you are? I’ve been referred to the UK General Medical Council’s rule #17, which states, “If you identify yourself as a doctor in publicly accessible social media, you should also identify yourself by name. Any material written by authors who represent themselves as doctors is likely to be taken on trust and may reasonably be taken to represent the views of the profession more widely.”

Regarding the previous sentence, I agree with the first part about trust and strongly disagree with the second part. How could anyone think that what a single doctor writes is representative of the profession more widely? I am reasonably certain that is not the case in my situation.

In the comments section of that post or via email, more than 50 people have asked me questions about their own or a family member’s abdominal pain. I’ve had to add numerous disclaimers over the years reminding readers that I could not give medical advice without examining the patient.

Despite the disclaimers, the questions keep coming with the most recent one submitted two days ago. I can only guess that they are either reluctant to ask questions in person or not getting satisfactory answers from the doctors they are seeing.

Pre-med and medical students and residents frequently look to me for career counseling. Last week I even got a question from a high school student who was thinking about becoming a doctor. The students and residents occasionally preface their questions by saying that they didn’t want to ask someone from their school or residency program for fear it would reflect poorly on them.

I have been amazed at how many readers seem to trust me enough to ask personal questions about their health or their career. To be able to connect with so many people despite my use of a pseudonym is rewarding.

Patients and aspiring doctors — that’s who would ask an anonymous blogger for advice.

Who asks an anonymous physician blogger for advice? 27 comments

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Dr. Drake Ramoray

I agree with this post. I also do it because when ivory tower out of touch eggheads who pretend they can tell me how to run my practice think I’m really Dr. Drake Ramoray it is priceless entertainment.

Patient Kit

I think we’re all smart enough to figure out that you are really Dr Joey Tribbiani. 😉

Dr. Drake Ramoray

Believe it or not it has happened more than once.

Patient Kit

LOL! Even with your photo? Well, some peeps are pop culturally illiterate — or just too busy for “friends”. I can see how it could amuse you though if ivory tower peeps make that mistake.

NPPCP

I second this. The opportunity to interact with other anonymous participants on this blog has been very eye opening. Those who “don’t advocate my line of thinking” have always shown their true colors. What I mean by this is: there are those who may not agree with my positions (deceasedmd, fedupmd, Dr. Drake, buzzkiller – I don’t think he really cares about positions, just staying afloat daily, southerndoc) but are able to engage honestly. I have come to respect the family practice physician position much more fully through my interactions with them. Then there are those who literally say nothing because they can’t find anything good to say. They never respond to my comments, no matter the relevance. That lack of response from an individual who doesn’t have to worry about identity tells one all they need to know about their willingness to hear opposing viewpoints.These two groups would be unable to completely speak their minds if their identities were known. What HAS surprised me here is the level of human ugliness that can surface when an individual has an unfettered anonymous podium. It is a shame in that respect. The ability of humans to completely degrade another class or profession or viewpoint has opened my eyes to things I wish I didn’t know sometimes. These are the individuals who care for other humans daily. In the end, as SS says, the journey and participation has been more fulfilling than worrisome. Thanks for the great post doctor – if you REALLY ARE ONE! (ha)

Skeptical Scalpel

There is very little ugliness by those who comment on this site. It is well-moderated.

I’m really a doctor. I must be because the Internet says so. 🙂

Patient Kit

Anonymity has it’s advantages and disadvantages. On the Internet, in general, some pretty nasty stuff goes down regularly hiding behind anonymity. But in the short time that I’ve been reading and participating on KMD, I have not seen that kind of behavior here and I’m inclined to believe that it frees some people here to be more open and honest. I know it works that way for me.

I’m not a doctor, so I have different reasons for my anonymity — I’m a job hunting cancer patient who can’t afford to have potential employers know what I’ve been through this year, healthwise. I wouldn’t even trust a cancer nonprofit (or a hospital or doctor) would hire me if they knew I had cancer. When it comes to people, both anonymous and known, grain of salt and trust your instincts.

The one anonymous thing that drives me crazy here is the multiple posters named “guest”. I gave up trying to sort them out. But posters like Skeptical Scalpel, Dr Drake, buzzkiller and others have unique voices to me, despite their anonymity.

Suzi Q 38

You don’t have to tell your employer about your pre-existing cancer.

querywoman

Sure, it’s illegal for them to ask. Nevertheless, they can still discriminate if they find out. Patient Kit may have a significant gap in employment history to explain, though that’s common now.

Suzi Q 38

This is why I did not disclose my small ovarian tumor, or my complex atypical hyperplasia.
Once I had the hysterectomy, I figured it was gone for now. My boss asked me point blank if I had cancer, and I said “no.” I then went on and on about how much I was bleeding and how gross it was, so that he would just STOP asking me due to TMI. Men in general do not want to hear about all that female stuff.

He never asked again.

When I had the cervical spine surgery on my neck, I never mentioned that it could be mechanical, MS or TM. I just told him that my back hurt and that I needed surgery soon.
I had already found a substitute teacher to take my classes for 3 months.

I admire him for not annoying me and laying me off. The problem is that the teacher’s union frowns upon stuff like that. I am only a part time teacher, but still.

I heard that he is out sick because he got a bad case of the shingles and it almost rendered him blind.

If he wasn’t sympathetic before, he is now that his heath is threatened.

Actually, I am so pleased that I received only sympathy, good wishes and patience. When I first returned from work, I had to sit the majority of the time while I taught my classes. My students had to do a lot for me. If I got too tired, I called a substitute.

Now that a year has passed, I am the one teaching extra classes for the other teachers when they are sick or on vacation.

querywoman

Some people are just curious.
On the other hand, I found nondoctor men quite sympathetic to my serious menstruation disorder. Other women were not, especially not female gynecologists.
Shingles, like all skin disease, has stigma along with the suffering.

JR

I was actually told elsewhere “patients who do not list their name when telling their stories are fabricating stories to get attention…” ouch.

Seriously, I don’t want my co-workers knowing my medical problems.

Patient Kit

If only. I wish this particular year of my life was fiction. Maybe it will be some day. Maybe I should write a novel and turn my experiences into fiction.

Skeptical Scalpel

I have no problem with patients being anonymous online. If I can do it, you can too.

Suzi Q 38

When I complain about a situation or a doctor(s), I would rather be anonymous to spare my errant doctors embarrassment.
I tell my story so that other patients may benefit from my errors in seeking treatment and trusting physicians I had no idea were jaded.
You can always say that I can’t be real because I don’t use my real name. Quite the contrary. My physician problems are so numerous and complex that it is truly difficult to make this stuff up.

I’d amend the end of that post now, as Web 2.0 evolved into an odd amalgam of tell-all and anonymity. In any case, anonymity clearly has pros and cons. For those disempowered or at risk, anonymity is essential to “speak truth to power”, to receive or share support for embarrassing or highly unpopular issues, to separate one’s online persona from real life, etc.

The drawbacks, especially when speaking from a position of authority as physician-bloggers do, are lack of accountability and idealization. As Skeptical Scalpel writes, anonymity allows edginess and offbeat humor. Yes, in a sense this is “more honest,” but it also risks being less professional. Not referring to Skeptical Scalpel or anyone else here, but I’ve seen loads of immature rants posted by anonymous (alleged) physicians and others, which reflect poorly on their colleagues and their profession. Meanwhile, there’s the converse problem too: idealization of a wise doctor whose clay feet are hidden behind a pseudonym. Yes, credibility is part of it; we all develop online reputations if our real or made-up names are trackable. Even anonymous doctors can earn respect. Yet it should come as no surprise when those in need turn to mysterious oracles for personal advice. They always have.

Without condemning those who choose otherwise, I’ve always used my real name in professional contexts online, and save pseudonyms for discussions I don’t want linked back to my work. I think this keeps ME more honest and accountable in forums where it really counts, and leaves me free to be a goof (or whatever) where it won’t damage patients or the practice of medicine. Just my humble opinion.

Skeptical Scalpel

Steven, Interesting blog post and comments here. Thanks. I never thought of it from the psychiatric point of view.

Sid Schwab

I blogged under my real name, mainly because I’d written a book to which I linked on my blog. But the strangeness of people happily asking for advice from a doc-blogger applies, anonymous or not. Many of my posts (blog long-since quiescent except for continued comments and questions to which I still respond) have had several hundred comments and questions, to which my replies tend to have a certain sameness: “because I’m so far away there’s no way I can offer specific advice or diagnosis. But in general…” One post got so much repetition I finally shut off comments.

I always enjoyed providing useful general information and the occasional good story; and I still find it gratifying that the blog lives on as a useful source for people. But the extent to which people seem willing to trust a guy they have no way of knowing remains mystifying. And it’s a little frustrating not to be able to help.

Good points, but one of the major problems with responding to questions about specific medical problems is, as I state on my blog, I cannot examine the patient, ask any questions, or see the lab work and imagine studies. People think they are giving me a detailed story, but there are always a lot of things left out. It is hard to give meaningful advice under those circumstances.

Patient Kit

I agree that many of the discussions here are informative, productive and entertaining. And I appreciate that KMD is a place where patients can participate and join the discussion with docs, nurses and others in healthcare. We are all important parts of our healthcare system and I think there is value in having a place where we can all take the time to share our experiences and points of view. There are plenty of sites where patients talk to each other. But docs and patients talking together about the things we talk about here? That’s special. As a patient, I feel listened to and treated respectfully here.

querywoman

Dear Skeptical Scalpel, I have found the new social entity of online blogs liberating. I can gripe about my family online.
My parents, like most people, were a composite of good and bad. I loved them both, regardless of the bad.
I find also that most people who rant about family problems are anonymous.
I think the anonymity has also been very liberating for doctors and patients. You can’t name patients for confidentiality reasons anyway. If you use your real name to discuss a patient, someone might figure it out easily.

Skeptical Scalpel

I agree, blogs are a good place to vent. I have received two emails in the last 24 hours from people who are doing just that. One didn’t even have a question.

querywoman

Absolutely! I don’t begrudge you docs an anonymous place to vent, though many choose to reveal their identity on kevinmd.
You don’t have to share what kind of emails you get. I am sure it’s also helped open your eyes.
In the case of my family, I loved both my parents, and chose not to vent about them publicly. I thought I might say something publicly now that they are gone, but I’m not sure.
On the family-griping blogs, some really wild stuff comes out. And anonymity is the norm on those!

As I once responded to your comment to my blog post on this very topic (“Should Doctors Use Their Real Names on Social Media?” – http://ethicalnag.org/2013/05/10/anonymous-doctors-social-media/) – you write openly (and well) about things like medicalization and other controversial issues in medicine that I believe would benefit from the heft of your real name. That’s just one reason I’m a big fan of doctors using their real names online. In fact, I’d love to hear from more docs here who do, especially on the pros and cons of doing so.

Your straightforward opinions are “about the author” whether you write anonymously or not. Your colleagues may know your name, and those of us who have read interviews about you may know your name, but I suspect that – especially now that you’ve retired – the rationale for anonymity seems less relevant. I’m guessing you would also “tell the truth” with the same edgy-ness or humour even if you did reveal your real name. Many docs do.

Sadly, I’ve also observed many anonymous docs online, however, who express entirely inappropriate, crude or cowardly statements that I’m pretty sure they’d never have the guts to express publicly if their true identity is revealed.

And it’s not just MDs who are asked for medical advice online, BTW. I’ve had to disable the comment feature on a number of my blog posts about women’s heart health because – despite my very clear online disclaimer (i.e. that I’m not a doctor, a nurse or any kind of health care professional but merely a dull-witted heart attack survivor), I was overwhelmed with desperate requests for information, help and even diagnoses from perfect strangers.

These must be the patients for whom asking even anonymous online physicians seems too tough a challenge!

Skeptical Scalpel

Carolyn, thanks for the comments. I agree that there are a lot of people who do not seem to be getting what they need from their doctors. I am truly amazed at the number and content of the questions I continue to receive.

Skeptical Scalpel

Brett, I appreciate the kind remarks. I hope you never have a problem that you need me to solve.